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Anyone who believes that they hold no biases or negative feelings about certain groups is most likely fooling themselves as well as trying to fool others! However, acknowledging these feelings, accepting them as a fact of human nature but working consciously to avoid letting these preconceived notions about the group or groups you believe an individual patient belongs to will help you to treat that patient with respect and draw sound medical conclusions based on that single individual’s symptoms and behavior rather than personal feelings you may hold about the group to which you assume he belongs.

After having just finished Gail Price-Wise’s excellent book about the Willie Ramirez case: An Intoxicating Error: Mistranslation, Medical Malpractice, and Prejudice, this need for self-awareness of caregivers is foremost in my mind.  Yes, it is true, that the mis-translation of the single word, “intoxicado”, which in the Cuban Spanish of the relatives who brought an unconscious 18-year old Willie into the ER of a Florida hospital, means something is wrong because of something one ate or drank, led to a misdiagnosis that resulted in Willie becoming a quadriplegic.  It is also true that the lack of cultural competency training and lack of self-awareness of both the ER and ICU residents’ that led them to unconsciously let prejudices and views of young Cubans as most likely being drug users or alcohol abusers, thus missing vital medical cues and simply treating Willie by pumping his stomach.   By the time the ICU doctor began to notice symptoms that Willie might have an intracranial bleed and requested a neurological consult, surgery was too late. Price-Wise’s analysis and background information about Dr. Blake, the ER physician and Dr. Cabrera, the ICU doctor on call, strongly support the need for developing self-awareness as well as training in cultural competency in healthcare. Dr. Blake is a tall, fair man of British descent.  He does not speak any Spanish but interviewed Willie’s mother through interpretation by Ana the mother’s outspoken friend, but a very poor English speaker, and her daughter who was also Willie’s girlfriend.  He states that he had trouble understanding the entire conversation, but got the ‘gist’ of it, which he (wrongly) understood to be that “the patient had had a fight with his girlfriend and his mom thought he was intoxicated.” (Price-Wise, 2015) His treatment was based upon this understanding, though both the mother and her friend insist that they assured Dr. Blake that no alcohol or drugs had been used. Price-Wise also points to cultural differences that Dr. Blake did not understand. An important one was that in Willie’s family’s culture, authority figures are not questioned or contradicted and that a more in-depth interview with the family, one that involved the establishment of a personal relationship, was needed. Instead, he focused upon his misinterpretation of the word “intoxicado” and his stereotypical view (gained from frequent media reports) of the involvement of young Cubans in drug abuse. Dr. Cabrera, on the other hand, is Bolivian and thus a fluent speaker of Spanish. However, as one with partially indigenous roots (much frowned upon in middle-to-upper class Bolivian society) he was proud of his ability to rise above his mixed racial background and establish himself as one of the educated upper class.  Willie was from a working-class Cuban family. Even the Spanish they speak is different from the Castilian Spanish spoken by Dr Cabrera.  Before even delving into the patient’s medical history, Dr. Cabrera had drawn a number of stereotypical conclusions about Willie.  Price-Wise quotes Dr. Cabrera as stating, “I’ll be honest. When you see a young, comatose, Hispanic male, the first thing you think of is NOT a brain hemorrhage.” Had both physicians been more aware of their individual biases and stereotypes, they might have been able to have avoided allowing them to influence their diagnoses or, at the very least, carefully test them against medical indications.  Had they had training that included information about Cuban culture and communication styles, they might have paid better attention to the family’s descriptions regarding the events that led to Willie’s seizure and its possible causes. Had the hospital in which this tragic episode took place employed a trained medical interpreter, many of these misunderstanding might not have taken place and Willie might have made a full recovery. Price-Wise’s book presents real-life proof of why the training provided by What Language Does Your Patient Hurt In? A Practical Guide to Culturally Competent Patient Care, is a necessity in today’s diverse healthcare environment.
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Health Careers